Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes

Abstract

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again. Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate. Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.

Relationship of the SIRSI Score to Return to Sports After Surgical Stabilization of Glenohumeral Instability

“…Although the SIRSI score has been reported in the literature, 5,12,14-16,26 only some studies analyzed its association with return to sports. 12,14-16 Hurley et al 14 found that patients who did not return to sports after ABR showed lower mean SIRSI scores than those who returned to sports (39.8 vs 68.9, respectively).…”

“…Although the SIRSI score has been reported in the literature, 5,12,14-16,26 only some studies analyzed its association with return to sports. 12,14-16 Hurley et al 14 found that patients who did not return to sports after ABR showed lower mean SIRSI scores than those who returned to sports (39.8 vs 68.9, respectively). Moreover, Bohu et al 5 found that the likelihood of return to sports after a Latarjet procedure was significantly associated with preoperative SIRSI scores.…”

“…12,14 Drawing from the ACL-RSI score, 35 Gerometta et al 12 proposed and validated the Shoulder Instability-Return to Sport after Injury (SIRSI) score to quantify the psychological readiness of athletes to return to sports after shoulder instability. Although the SIRSI has been used in several studies, 5,12,[14][15][16]26 few have analyzed the results between athletes who returned to sports and those who did not. 5,12,14 Hurley et al 14 showed that patients who did not return to sports exhibited poor psychological readiness compared with those who returned to sports after ABR.…”

Long-term outcomes of anterior shoulder instability treated with open latarjet procedure – a systematic review of outcomes at a minimum 15-year follow-up

“…5,6 Although a myriad of management options exist, the open Latarjet (OL) procedure has emerged as the procedure of choice for many, with recent consensus guidelines recommending its use in cases of recurrent shoulder instability in patients with >15% glenoid bone loss. [7][8][9][10][11] The OL procedure has previously been reported to result in excellent clinical outcomes in the short term, with high rates of return to play (RTP) and low recurrence rates at medium-term follow-up, 10,[12][13][14][15][16][17] with the procedure being increasingly performed using an arthroscopic technique. [18][19][20][21] Furthermore, a systematic review of 845 shoulders by Hurley et al 22 reported excellent clinical outcomes at a 10-year follow-up post-OL procedure.…”

Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability

“… 15 As both arthroscopic Bankart repair (ABR) and open Latarjet (OL) procedures have been shown to result in excellent clinical outcomes in the long term, collision athletes often elect for surgical stabilization in the setting of anterior shoulder instability. 11 , 12 , 13 , 20 …”